![]() ![]() The major factors associated with the pathogenesis of phthisis are ocular hypotony, deranged blood-ocular barriers, and intraocular inflammation. Dystrophic calcification is common, and osseous metaplasia sometimes occurs, forming what is called "intraocular bone". Microscopic features include internal disorganization, inflammatory reaction, a reactive proliferation of various cells, calcification, and ossification.The globe is reduced in size (usually <20 mm) with a thickened/folded posterior sclera. Their descriptive classification system including three different stages – (1) ocular atrophy without shrinkage (2) with shrinkage and (3) with shrinkage and disorganization. Hogan and Zimmerman were the first ones who stated that both terms – atrophy and phthisis bulbi – refer to consecutive stages in the degeneration process of a severely damaged eye. Over the last 200 years, the clinical interpretation of phthisis bulbi has often been modified according to the underlying disease and structural changes a clear distinction from ocular atrophy was often difficult and controversial. The term phthisis bulbi derives from the Greek word phthiein or phthinein, meaning shrinkage or consuming, and was first used by Galen. Rare tumors including adenoma of the nonpigmented ciliary epithelium, double pseudo-neoplastic proliferation of the RPE, primary retinal glial tumor with features of myxopapillary ependymoma, osteogenic sarcoma, concurrent benign teratoid medulloepithelioma and pineoblastoma, and conjunctival spindle cell carcinoma.Osteoporosis-pseudoglioma syndrome (OPPG).Persistent hyperplastic primary vitreous.Proliferative diabetic retinopathy (PDR).Autosomal dominant neovascular inflammatory vitreoretinopathy.In the advanced stages of intermediate uveitis, cyclitic membranes may form leading to hypotony and phthisis. Intermediate uveitis is the most common inflammatory cause of end-stage eye disease.Posterior segment surgeries (vitrectomy for endophthalmitis, retained intraocular foreign bodies, suprachoroidal hemorrhage, silicone oil removal, vitreoretinal surgery for retinal detachment with complex proliferative vitreoretinopathy, after penetrating trauma, combined rhegmatogenous, & tractional retinal detachment in diabetics, retinectomy for intractable glaucoma pneumatic retinopexy, suprachoroidal hemorrhage drainage).Anterior segment surgeries (cataract surgery via anterior route and lensectomy, glaucoma surgery, corneal surgeries).Common causes include trauma, surgery, infection, inflammation, malignancy, retinal detachment, and vascular lesion Traumatic Phthisis bulbi is an end stage ocular disease which can result from a variety of ocular insults including. Grade V : Phthisis bulbi with intraocular calcium deposition.Grade IV : Phthisis bulbi with intraocular ossification. ![]() Grade III : Atrophia bulbi with shrinkage and disorganization (phthisis bulbi).Grade II : Atrophia bulbi with shrinkage.Grade I : Atrophy bulbi without shrinkage.Yanoff and Fine proposed the following descriptive grading system based on clinicopathological features: A mnemonic rule used to describe phthisis bulbi is ''7S" referring to : Soft - Shrunken - Shapeless - Sightless - Structureless - Squared - Sore. Also called end-stage eye, phthisis bulbi can be described as a shrunken, collapsed in form, non-functional eye and presents with a small squared off shape, opaque and thickened cornea, thickened sclera, neovascularization of iris, cataract, cyclitic membrane, ciliochoroidal detachment, and retinal detachment. Phthisis bulbi is an clinical condition representing end-stage ocular response to severe eye injury or disease damage, related to a variety of causes leading to scarring, inflammation, scaring, atrophy and eventually disorganization of the globe and intraocular contents. ![]()
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